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Utah rates for HCPCS L0700

Cervical-thoracic-lumbar-sacral orthosis (CTLSO), anterior-posterior-lateral control, molded to patient model, (Minerva type)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,380.38 / $13,182.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,737.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,698.24 / $2,187.76
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,995.26 / $3,467.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,659.59 / $2,454.71
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,290.87 / $2,344.23
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,344.23 / $2,818.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,148.15 / $1,513.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,148.15 / $1,621.81